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Inflammation and Stress Biomarkers Mediate the Association between Household Food Insecurity and Insulin Resistance among Latinos with Type 2 Diabetes.

ABSTRACT: BACKGROUND:Household food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved. OBJECTIVE:We examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association. METHODS:HFI was measured with the 6-item US Household Food Security Survey module. IR was calculated from fasting plasma blood glucose and serum insulin. Inflammation was indicated by high-sensitivity C-reactive protein (hsCRP), and stress hormones included urinary cortisol, metanephrine, and normetanephrine. To test for an indirect effect of HFI on homeostasis model assessment of IR, a parallel multiple mediation model was run with biological markers that significantly differed between food security status-entered as mediators in the model. We used 95% bias-corrected bootstrap CIs, with 10,000 bootstrap samples, to assess the significance of the indirect effects. RESULTS:The 121 participants with T2D were primarily Puerto Rican (85.8%), aged mean = 60.7 y, and 74% were female. Eighty-two (68%) were classified as food insecure. Compared with food-secure individuals, food-insecure individuals had a significantly higher IR [mean difference (?) = 7.21, P = 0.001], insulin (? = 9.7, P = 0.019), glucose (? = 41, P < 0.001), hsCRP (? = 0.8, P = 0.008), cortisol (? = 21, P = 0.045), and total cholesterol (? = 29, P = 0.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. The mediation model showed a significant direct effect of HFI on hsCRP (P = 0.020) and on cortisol (P = 0.011). There was a direct effect of cortisol (P = 0.013), hsCRP (P = 0.044), and HFI on IR (P = 0.015). The total combined indirect effect of HFI through cortisol and hsCRP indicated partial mediation. CONCLUSIONS:Among Latinos with T2D, HFI is associated with IR partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and IR are warranted. This trial was registered at clinicaltrials.gov as NCT01578096.

SUBMITTER: Bermudez-Millan A

PROVIDER: S-EPMC6543200 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Inflammation and Stress Biomarkers Mediate the Association between Household Food Insecurity and Insulin Resistance among Latinos with Type 2 Diabetes.

Bermúdez-Millán Angela A Wagner Julie A JA Feinn Richard S RS Segura-Pérez Sofia S Damio Grace G Chhabra Jyoti J Pérez-Escamilla Rafael R

The Journal of nutrition 20190601 6

<h4>Background</h4>Household food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved.<h4>Objective</h4>We examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association.<h4>Methods</h4>HFI was measured with the 6-item US Household Food Security Survey m ...[more]

PMID: 31006809

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Project description:IntroductionNumerous natural and man-made factors have afflicted Ethiopia, and millions of people have experienced food insecurity. The current cut-points of the WFP food consumption score (FCS) have limitations in measuring the food insecurity level of different feeding patterns due to the diversified culture of the society. The aim of this study is to adapt the WFP food security score cut-points corrected for the different feeding cultures of the society using effect-driven quantile clustering.MethodThe 2012, 2014, and 2016 Ethiopian socio-economic household-based panel data set with a sample size of 3,835 households and 42 variables were used. Longitudinal quantile regression with fixed individual-specific location-shift intercept of the free distribution covariance structure was adopted to identify major indicators that can cluster and level quantiles of the FCS.ResultHousehold food insecurity is reduced through time across the quintiles of food security score distribution, mainly in the upper quantiles. The leveling based on effect-driven quantile clustering brings 35.5 and 49 as the FCS cut-points corrected for cultural diversity. This corrected FCS brings wider interval for food insecure households with the same interval range for vulnerable households, where the WFP FCS cut-points under estimate it by 7 score. Education level, employment, fertilizer usage, farming type, agricultural package, infrastructure-related factors, and environmental factors are found to be the significant contributing factors to food security. On the other hand, the age of the head of the household, dependency ratio, shock, and no irrigation in households make significant contributions to food insecurity. Moreover, households living in rural areas and farming crops on small lands are comparatively vulnerable and food insecure.ConclusionMeasuring food insecurity in Ethiopia using the WFP FCS cut-off points underestimates households' food insecurity levels. Since the WFP FCS cut-points have universality and comparability limitations, there is a need for a universally accepted local threshold, corrected for local factors those resulted in different consumption patterns in the standardization of food security score. Accordingly, the quantile regression approach adjusts the WFP-FCS cut points by adjusting for local situations. Applying WFP cut-points will wrongly assign households on each level, so the proportion of households will be inflated for the security level and underestimated for the insecure level, and the influence of factors can also be wrongly recommended the food security score for the levels. The quantile clustering approach showed that cropping on a small land size would not bring about food security in Ethiopia. This favors the Ethiopian government initiative called integrated farming "ኩታ ገጠም እርሻ" which Ethiopia needs to develop and implement a system that fits and responds to this technology and infrastructure.

Project description:This study examined the burden of food insecurity in India's un-notified slums, using an SDG framework to identify correlates of food insecurity. A convenience sampling approach was employed in selecting 38 slums from 675 un-notified slums across four geographic zones. Ten percent of the households in each slum site were selected from each zone, and one household member was interviewed, based on their availability and fulfilment of the eligibility criteria. Eligible individuals included those aged 18 years and above, who were resident in the selected slums and provided consent. Individuals with mental or physical challenges were excluded. A total sample of 907 study participants were included. Results showed that 43% (n = 393) of the participants were food insecure. More than half were females (73%, n = 285), who had not completed any schooling (51%, n = 202). One-third (n = 128) resided in the Northern Region of Delhi. SDG-related predictors of food insecurity included: household educational level (SDG 4 Quality education) (p = 0.03), coverage of health service needs (SDG 3 Good health and well-being) (p = 0.0002), electricity needs (SDG 7 affordable and clean energy) (p<0.0001), and employment needs (SDG 8 Decent and economic growth) (p = 0.003). Having healthcare needs that were partially or fully met was equally associated with higher food insecurity: this could be attributed to high healthcare costs and the lack of federal subsidies in un-notified slums, collectively contributing to high out-of-pocket health costs. Failure to fully meet employment needs was also significantly associated with higher food insecurity. However, met needs for electricity, finance, women's safety and satisfactory family relationships, were associated with lower food insecurity. Household predictors of food insecurity included: number of household members, and the presence of physically disabled household members. Necessary interventions should include connecting food insecure households to existing social services such as India's Public Distribution System, and multi-sector partnerships to address the existing challenges.

Project description:Evidence increasingly indicates that poor sleep quality is a major public health concern. Household food insecurity (HFI) disproportionately affects Latinos and is a novel risk factor for poor sleep quality. Psychological distress may be a potential mechanism through which HFI affects sleep quality. Sleep, food insecurity, and distress are linked to type 2 diabetes mellitus.We examined the relations between HFI, psychological distress, and sleep quality and tested whether psychological distress mediates the relation between HFI and sleep in people with diabetes mellitus.Latinos with type 2 diabetes mellitus (n = 121) who completed baseline assessments for the CALMS-D (Community Health Workers Assisting Latinos Manage Stress and Diabetes) stress management intervention trial completed the US Household Food Security Survey, and measures of depressive symptoms [Personal Health Questionnaire Depression Scale (PHQ-8)], anxiety symptoms [Patient-Reported Outcomes Measurement Information System (PROMIS)-short], diabetes distress [Problem Areas in Diabetes Questionnaire (PAID-5)], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Psychological distress was operationalized with the PHQ-8, PROMIS-short, and PAID-5 scales. We used unadjusted and adjusted indirect effect tests with bias-corrected bootstrapped 95% CIs on 10,000 samples to test both relations between variables and potential mediation.Mean age was 61 y, 74% were women, and 67% were food insecure. Experiencing HFI was associated with both greater psychological distress and worse sleep quality (P < 0.05). Depressive symptoms (adjusted R2: 2.22, 95% CI: 1.27, 3.42), anxiety symptoms (adjusted R2: 1.70, 95% CI: 0.87, 2.85), and diabetes mellitus distress (adjusted R2: 0.60, 95% CI: 0.11, 1.32) each mediated the relation between HFI and worse sleep quality with and without adjustment for age, education, income, marital status, and employment status.Household food insecurity is a common and potent household stressor that is associated with suboptimal sleep quality through psychological distress. Efforts to improve food security and decrease psychological distress may yield improved sleep in this high-risk population. The CALMS-D stress management trial was registered at clinicaltrials.gov as NCT01578096.

Project description:Background: Food insecurity (FI), diabetes prevalence, and poor diabetes outcomes all disproportionately affect Latinos in the United States. Heart rate variability (HRV) reflects autonomic tone, is associated with glycemic control, and predicts mortality in type 2 diabetes. It is unknown whether FI is related to HRV and, if so, whether glycemic control accounts for this association. Objective: This exploratory cross-sectional study examined FI and HRV among US Latinos with type 2 diabetes. Methods: Participants reported demographic characteristics, socioeconomic status, and FI, including the 6-item USDA food security module and a 1-item measure of diabetes-specific food security. Participants wore an ambulatory electrocardiogram monitor for 24 h. In the time domain, HRV was assessed with the SD of the R-R interval (SDNN). In the frequency domain, the power spectrum was integrated over 3 frequency bands-very low frequency (VLF), low frequency (LF), and high frequency (HF)-and then natural log transformed. Unadjusted ANOVA and ANCOVA adjusted for age, sex, glycated hemoglobin (HbA1c), and indicators of socioeconomic status compared food security groups on HRV. Results: Participants' mean ± SD age was 59.7 ± 10.9 y, and 73% were women. Of the 94 participants, 63 reported FI according to the USDA food security module and 46 reported FI according to the diabetes-specific measure. Mean ± SD HbA1c was 8.6% ± 1.7% and was marginally higher among those reporting diabetes-specific FI than those reporting diabetes-specific food security. Participants who reported diabetes-specific FI had lower SDNN, VLF, LF, and HF HRV with effect sizes in the small-to-medium range. Differences remained significant even after controlling for age, sex, socioeconomic hardship, and HbA1c. The 6-item USDA food security module was not associated with HRV. Conclusions: Diabetes-specific FI may be a unique risk factor for poor health outcomes among US Latinos. Efforts to address FI could benefit diabetes outcomes.

Project description:BackgroundHousehold food insecurity, a measure of income-related problems of food access, is growing in Canada and is tightly linked to poorer health status. We examined the association between household food insecurity status and annual health care costs.MethodsWe obtained data for 67 033 people aged 18-64 years in Ontario who participated in the Canadian Community Health Survey in 2005, 2007/08 or 2009/10 to assess their household food insecurity status in the 12 months before the survey interview. We linked these data with administrative health care data to determine individuals' direct health care costs during the same 12-month period.ResultsTotal health care costs and mean costs for inpatient hospital care, emergency department visits, physician services, same-day surgeries, home care services and prescription drugs covered by the Ontario Drug Benefit Program rose systematically with increasing severity of household food insecurity. Compared with total annual health care costs in food-secure households, adjusted annual costs were 16% ($235) higher in households with marginal food insecurity (95% confidence interval [CI] 10%-23% [$141-$334]), 32% ($455) higher in households with moderate food insecurity (95% CI 25%-39% [$361-$553]) and 76% ($1092) higher in households with severe food insecurity (95% CI 65%-88% [$934-$1260]). When costs of prescription drugs covered by the Ontario Drug Benefit Program were included, the adjusted annual costs were 23% higher in households with marginal food insecurity (95% CI 16%-31%), 49% higher in those with moderate food insecurity (95% CI 41%-57%) and 121% higher in those with severe food insecurity (95% CI 107%-136%).InterpretationHousehold food insecurity was a robust predictor of health care utilization and costs incurred by working-age adults, independent of other social determinants of health. Policy interventions at the provincial or federal level designed to reduce household food insecurity could offset considerable public expenditures in health care.

Dataset Information

Inflammation and Stress Biomarkers Mediate the Association between Household Food Insecurity and Insulin Resistance among Latinos with Type 2 Diabetes.

Publications

Inflammation and Stress Biomarkers Mediate the Association between Household Food Insecurity and Insulin Resistance among Latinos with Type 2 Diabetes.

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